Acne is one of the diseases, if not the single disease, most closely associated in public perception with the specialty of dermatology. It is nearly ubiquitous, prompting millions of physician visits annually. Given its prevalence, it's hard to believe that acne could still be controversial. But it is.

For one thing, the “typical” acne patient may not even exist. Although acne is largely considered a disease affecting adolescents, data indicate that a majority of individuals seeking medical treatment for acne—61.9 percent—are 18 years of age or older. (Cutis; 86(2):94-9). Almost two-thirds of all acne patients are female. At the same time, anecdotal reports suggest pre-adolescent acne could be on the rise.

Long-standing acne therapies, including antibiotics, continue to attract scrutiny, while skeptics challenge new interventions, such as lights and lasers. Evidence continues to suggest ways to optimize older therapies, challenge long-held perceptions about these agents, and elucidate approaches to safe and effective use of acne drugs—all topics that are covered in this issue.

Despite advancements in acne care, some cases remain clinically challenging. Importantly, management of acne can be complicated not by the cutaneous manifestations of the disease only but also by the psychological impact of it. Acne has been associated with reduced quality of life and depression, and it is incumbent upon dermatologists, as addressed in this issue, to be sensitive to these realities.

The notion of acne as the quintessential disease of dermatology, may be apropos, because it captures the true art of dermatologic practice. A disease that appears to be “common” and not terribly complex on the one hand, is actually a multifactorial disease with effects (and contributors) that run far below the surface of the skin. Management of the acne patient requires a good deal of skill and the dermatologist's experienced touch. Like most skin diseases, acne is more than skin deep, and dermatologists who effectively counsel, educate, and manage their patients with this condition enbody the unique expertise of their specialty.